Why We Need to Retool "Use It Or Lose It": Healthy Brain Aging

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Cognitive health

Healthy brain aging: why we need to retool ‘Use it or lose it’

To help older adults protect brain health and function, add activities that ensure a flow of novelty, variety and challenge by Álvaro Fernández, MA, MBA By now you have probably heard about brain plasticity, the lifelong capacity of the brain to change and rewire itself in response to the stimulation of learning and experience. The latest scientific research shows that specific lifestyles and actions can improve the health and level of functioning of our brains, no matter our age. Of particular importance to maintaining cognitive functioning through life are the hippocampus (deep inside the brain, part of what is called the limbic system), which plays a role in learning and memory; and the frontal lobes (behind your forehead), which are key to maintaining decision-making and autonomy. Is there a way to physically protect these parts of the aging brain? Yes. But the right answer is far from “do one more crossword puzzle” or “do more X” (whatever X is). The key is to add significantly different activities to ensure a flow of novelty, variety and challenge, combining physical and mental exercise while not ignoring factors such as stress management and balanced nutrition.1 We need, in other words, to retool our understanding and practice of “Use it or lose it.” We must focus on the importance of getting out of our physical and mental routines and activities to get the benefits of real exercise—physical and mental.

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Debunking 10 common myths The extensive research process we undertook for our recent book, The SharpBrains Guide to Brain Fitness,1 highlighted the need to debunk some popular myths on brain health that may hinder efforts in the right direction. These include: Myth 1. Genes determine the fate of our brains. Facts: Lifelong neuroplasticity allows our lifestyles and actions to play a meaningful role in how our brains physically evolve, especially given longer life expectancy. Myth 2. Aging means automatic decline. Facts: There is nothing inherently fixed in the precise trajectory of how brain functions evolve as we age. Myth 3. Medication is the main hope for cognitive enhancement. Facts: Noninvasive interventions can have comparable and more durable effects, side effect-free. Myth 4. We will soon have a magic pill or general solution to solve all our cognitive challenges. Facts: A multipronged approach is recommended, centered around nutrition, stress management, and both physical and mental exercise. Myth 5. There is only one “it” in “Use it or lose it.” Facts: The brain is composed of a number of specialized units. Our life and productivity depend on a variety of brain functions, not just one. Myth 6. All brain activities or exercises are equal. Facts: Varied and targeted exercises are the necessary ingredients in brain training, so that a wide range of brain functions can be stimulated. Myth 7. There is only one way to train your brain. Facts: Brain functions can be impacted in a number of ways, such as meditation, cognitive therapy and cognitive training. Myth 8. We all have something called “brain age.”

Facts: Brain age is a fiction. No two individuals have the same brain or expression of brain functions. Myth 9. That “brain age” can be reversed by 10, 20, 30 years. Facts: Brain training can improve specific brain functions, but, with research available today, cannot be said to roll back one’s “brain age” by a number of years. Myth 10. All human brains need the same brain training. Facts: As in physical fitness, users must ask themselves: What functions do I need to improve on? In what timeframe? What is my budget? With these facts in mind, let’s delve into different types of mental exercise and how they benefit the brain. Exercise requires crosstraining and challenge The most common enemies of novelty, variety and challenge are routine and doing things inside our comfort zones. This is true for both physical and mental exercise. Consider the type of mental exercise experienced daily by London cab drivers. Every new ride requires a complex mental task to decide the most efficient route to complete the continually novel challenge at hand. Contrast that with the routine mental activity (we couldn’t really call it “mental exercise”) undertaken by London bus drivers who, day after day, follow a precise itinerary. Clearly, if you lived in London and wanted to protect and even grow your hippocampus, you would choose to drive a cab, not a bus. Of course, the brain has a variety of structures and functions to maintain, well beyond the hippocampus, hence the need for cross-training. Not all mental exercise is equal in terms of its structural and functioning benefits—in the same way that different types of physical fitness training bring different benefits. Mental exercise strengthens the synapses or connections between neurons (nerve cells), thus improving neuron survival and cognitive functioning. Remember that “cells that fire together wire together.”

Resource The SharpBrains Guide to Brain Fitness: 18 Interviews with Scientists, Practical Advice, and Product Reviews, to Keep Your Brain Sharp Authors: Álvaro Fernández and Elkhonon Goldberg, PhD San Francisco CA: SharpBrains Inc., May 2009 Paperback, 182 pages, $24.95 The SharpBrains Guide to Brain Fitness is the result of over a year of extensive research including more than 100 interviews with scientists, professionals and consumers, and a deep literature review. Among the leading scientists interviewed, Arthur Kramer explains the need for walking book clubs and Yaakov Stern discusses building cognitive reserve. There is an accessible introduction to the brain and brain fitness research combined with over 100 references to peerreviewed scientific studies for deeper study. The resource also reviews 21 products for brain cross-training, targeted mental exercise, and emotional self-regulation.

There are four types of mental exercise with more supporting scientific evidence that they can enhance specific brain functions.1 They are: • Cognitive therapy (CT). The way we perceive our experiences influences our behaviors, and we can learn cognitive skills to modify our thinking, resulting in actions. CT is commonly used in the context of anxiety and depression, but its core principles and techniques show promise in a variety of other applications such as healthy eating. • Meditation. This practice has been shown to improve specific cognitive functions such as attention and emotional self-regulation. Continued on page 42

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Healthy brain aging: why we need to retool ‘Use it or lose it’ Continued from page 41 • Biofeedback. A growing number of relatively inexpensive devices can measure and graphically display various physiological variables such as heart rate variability, so that users can learn to self-adjust and identify and manage emotions better. • Brain Fitness Software. These fully automated applications are designed to assess and enhance specific cognitive abilities. This is the area that has exploded since 2007—and where we observe the most confusion since different packages tend to target different functions (e.g., working memory, auditory processing, divided attention) in ways that are not transparent or understood by users. Yet, even mental cross-training isn’t enough on its own. What else is needed to maintain the complex system of the brain?

Brain-friendly living Forget a magic pill. Healthy brain aging requires a brain-friendly lifestyle, in addition to mental cross-training. This lifestyle should at least include:1 • Balanced nutrition. As a general guideline, what is good for the body and heart is also good for the brain. Gingko biloba and other supplements do not seem to bring the benefits people expect. • Stress management. Chronic stress reduces and can even inhibit neurogenesis (the creation of new neurons) and affects memory and other brain functions. It is then important to learn how to manage stress. • Physical exercise. Physical exercise improves cognitive functioning through increased blood supply and growth hormone levels in the brain. Of all the types of physical exercise, cardiovascular exercise that gets the

heart beating has been shown to have the greatest effect. • Overall mental stimulation. Cumulated mental stimulation throughout our lives (via education, jobs, leisure activities) can help build a neuroprotective cognitive reserve that can help delay the onset of Alzheimer’s-related symptoms. Healthy, active living—with a focus on good health in all the dimensions of wellness—is the kind of brain-friendly lifestyle that can help protect cognitive function across the life span. Implications for active-aging professionals Active aging is one of the areas where this type of brain research can make a profound difference in years to come. While much more research needs to be done to identify the right type of cognitive exercise to improve the daily functioning of any given individual, it is beyond reasonable doubt that novelty, variety and challenge contribute to healthy brain aging better than common alternatives (more passive or repetitive pastimes).

SharpBrains’ checklist for providers evaluating brain fitness programs 1. Target users: Who among your clients is ready and willing to do the program? How are they reacting to the pilot testing of the activities? 2. Cognitive benefits: What are the specific benefits claimed for using each program? Under what scenario of use (how many hours/week, how many weeks)? What specific cognitive skill(s) does the program train? How will you measure progress? 3. Appropriate challenge: Do the exercises adjust to the individual and continually vary and challenge residents at an appropriate pace? 4. Scientific credentials: Are there scientists, ideally neuropsychologists, behind the program? Is there a clearly defined and credible scientific advisory board? Are there

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published, peer-reviewed scientific papers? 5. Return on investment: What are your key objectives, and how will you independently measure the progress due to this program to expand, maintain or change course? 6. Total cost of ownership: What may be the total cost of ownership over the next three to five years if you go with different vendors: upfront fees, ongoing fees, hardware, software, training and support fees, cost of additional modules and staff time? How many clients will likely end up using the system, and therefore what is the cost of ownership per user? 7. Technical requirements: What are the technical requirements needed to successfully deploy and maintain the

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program? Does it require an Internet connection? Who will help solve potential glitches? 8. Staff training: What type of training will you and your staff need, and who will provide it? 9. References: What similar organizations have used this specific program? What proportion of their clients use it regularly? What benefits have they measured and observed in their clients, and as an organization? Is the use of the program growing, or is it flat or declining? 10. Product road map: What is the product roadmap for this company? What is the company developing and planning to offer next year, and in two to three years?

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Active-aging organizations can easily provide quality information for staff and clients and create a library of programs and activities to assist each person in finding an appropriate program—not necessarily with budget implications. Depending on the setting, older adults, or their families, can buy the programs based on the available information and firsthand testing. Finding the right mix between structure, science and fun involves trying options. There is no panacea, or program that works best for everyone. Some people prefer “fun games,” while others prefer more structured sessions or a more science-based approach. Some options for mental exercise require purchasing a device. Others require installing software in PCs in existing or new computer labs, or are fully available online. And still others may be technology-free, promising engaging combinations of interactive, group-based activities with pen-and-paper exercises.

How can you navigate this landscape? No program available today currently offers a dream combination of ideal characteristics, so you need to take into account your specific circumstances, priorities and budget. That’s why we suggest you launch a pilot and measure results in objective, independent ways before embarking on major rollouts. As you prepare your business case, try using the SharpBrains checklist on page 42 to select and introduce a new toolkit for cognitive exercise. Ready for the future? Based on our market research work, we see clear signs of a growing “Culture of Brain Fitness,” with a better integration of physical and mental exercise and even mainstream awareness and broad initiatives. Better tools to assess cognitive functions and to improve brain functions are underway. And more actors will take brain fitness into consideration—think of physicians, psychologists, insurance companies, on top of residential communities and seniors centers.

Can you, the ambassadors of active aging and brain fitness, incorporate novelty, variety and challenge into your work settings, and help reshape and retool “Use it or lose it” for your clients? Álvaro Fernández, MA, MBA, recently coauthored The SharpBrains Guide to Brain Fitness: 18 Interviews with Scientists, Practical Advice, and Product Reviews, to Keep Your Brain Sharp, with neuropsychologist Elkhonon Goldberg, PhD. Fernández is the CEO of SharpBrains Inc., and a member of the World Economic Forum’s Global Agenda Council on the Aging Society. For more information about SharpBrains, visit www.sharpbrains.com. Reference 1. Fernández, A., & Goldberg, E. (2009). The SharpBrains Guide to Brain Fitness: 18 Interviews with Scientists, Practical Advice, and Product Reviews, to Keep Your Brain Sharp. San Francisco CA: SharpBrains Inc.

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